We propose to expand and enhance an administrative data repository to facilitate comparative effectiveness research (CER) in complex patients. The data repository was developed with start-up funds from the WU Institute of Clinical and Translational Sciences. The start-up funds were provided to store and maintain multiple large administrative datasets and provide data management and analytic expertise for health services and outcomes research throughout the University. The size and complexity of these data provide ample opportunities to investigate processes of care, procedures, and therapies used to treat patients with multiple underlying illnesses. Grant funds are requested to further develop the server infrastructure for efficient storage and analysis of the large administrative data files and to purchase additional administrative data to extend the breadth of available information. We will develop a library of standard programming code to manage the multiple large and complex data files and to translate diagnosis and procedure codes into clinically meaningful classification schemas for analysis. Development of the programming code library will create an economy of scale through modification of existing code, rather than recreation of new code by individual investigators, thus allowing future investigators to more efficiently use their funds to perform innovative CER. We will provide education in the ethnical and secure use of administrative data for CER and develop policies to ensure compliance with federal and institutional data use agreements. To demonstrate the capacity of this administrative data repository for CER in the complex patient, we will determine the incidence of device associated infection after initial placement of an implantable cardiac device and after device revision/replacements in all patients, and in subsets of patients with diabetes and renal failure. We will assess the impact of these complications on mortality in all patients, and patients with diabetes and renal failure, in relation to time of diagnosis and device removal. We will also determine the incidence of recurrent infections as a function of time to re-implantation after removal of an infected device. PUBLIC HEALTH RELEVANCE: Funds from this infrastructure award will be used to expand an administrative data repository, by increasing the data server size and computing capacity, obtaining additional data files for research, and developing educational materials and programs. These enhancements will facilitate use of the large complex data files for comparative effectiveness research in complex patients.